获得性免疫缺陷综合征合并神经梅毒的MRI影像表现

MRI features of AIDS with neurosyphilis

目的 探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)合并神经梅毒患者的MRI影像特点,提高对AIDS合并神经梅毒患者MRI影像表现的认识。方法 回顾性分析首都医科大学附属北京佑安医院收治的AIDS合并神经梅毒患者的影像及临床资料。结果 纳入32例患者,共发现病灶29处,分布位置为颞叶7例(24.14%)、基底节6例(20.69%)、额叶6例(20.69%)、顶叶3例(10.34%)、枕叶3例(10.34%)、半卵圆中心2例(6.90%)、脑萎缩2例(6.90%)。临床分型包括无症状型9例(28.12%)、脑膜型2例(6.25%)、脑膜血管型5例(15.62%)、脑实质型15例(46.88%)和树胶肿型1例(3.13%)。MRI增强扫描脑膜型呈脑回样或局限性线样强化;脑膜血管型病灶呈斑片样及脑回样强化;脑实质型患者伴有脑萎缩;树胶肿型病灶呈结节状不均匀强化。经抗梅毒治疗后均有好转。结论 AIDS合并神经梅毒患者的MRI影像表现多样,需同时结合临床特征、实验室检查等综合分析以达到早期诊断的目的。

Objective To investigate the MRI manifestations of AIDS associated with neurosyphilis and improve the understanding of this condition.Methods Data showing the imaging characteristics and clinical manifestations in patients with clinically proven AIDS associated with neurosyphilis in Beijing You’an Hospital Affiliated of Capital Medical University were collected and analyzed retrospectively.Results A total of 32 patients were included and a total of 29 lesions were found.The location of lesions was:temporal lobe 7 cases(24.14%),basal gangli 6 cases(20.69%),frontal lobe 6 cases(20.69%),parietal lobe 3 cases(10.34%),occipital lobe 3 cases(10.34%),centrum semiovale 2 cases(6.90%) and cerebral atrophy was present in 2 cases(6.90%).According to the site of TP invasion and clinical manifestations,the types of cases were as follows:9 asymptomatic cases(28.12%),2 meningeal cases(6.25%),5 meningeal vascular cases(15.62%),15 parenchymal cases(46.88%) and 1 gumma case(3.13%).After injection of Gd-DTPA,gyria-enhancment was detected in meningal neurosyphilis,lamella and gyria-enhancment was found in meningovascular neurosyphilis,while irregular enhancing was noted in the cerebral gumma.Cerebral atrophy was manifested in a patient with general paresis of the insane.The symptoms improved a?ter anti-syphilis treatment.Conclusion AIDS with neurosyphilis has atypical MRI manifestations.Comprehensive analysis of imaging data and laboratory examination is helpful to assist in early diagnosis of neurosyphilis.